Hematoma-like dynamic hydrogelation through natural glycopeptide molecular recognition for infected bone fracture repair

Infected bone fractures remain a major clinical challenge for orthopedic surgeons.From a tissue regeneration perspective,biomaterial scaffolds with antibacterial and osteoinductive activities are highly desired,while advanced materials capable of mimicking the pathological microenvironment during the healing process of infected tissues remain an area deserving more research.Hematoma,the gel-like blood coagulum,plays an essential role in bone fracture repair because of its ability to serve as a dynamic and temporary scaffold with cytokines for both pathogen elimination and tissue healing.In light of this,we designed a dynamic hydrogel with hematoma-like antimicrobial or reparative performance for infected bone fracture repair in this study.The proposed dynamic hydrogel network was based on the reversible recognition of a natural glycopeptide antibiotic vancomycin(Van)and its target dipeptide D-Ala-D-Ala(AA),which could serve as a hematoma-like scaffold for obliterating bacteria in the fracture region and promoting bone repair by introducing an endogenous osteogenic peptide(OGP).In vivo experiments demonstrated that the hydrogel could rapidly eradicate bacteria,improve bone regeneration and restore the local inflammatory microenvironment.Together,findings from this study imply that the use of hematoma-like dynamic hydrogel could lead to a biomimetic revolution in surgical strategies against susceptible bone fractures.

Clinical Study of Tianji Robotic-Assisted Surgery for Upper Cervical Spine Fractures

Object: To compare the safety, clinical efficacy, and complication rate of “Tianji” robot-assisted surgery with traditional open surgery in the treatment of cervical vertebrae fracture. Methods: 60 patients with upper cervical vertebrae fracture admitted to Baise People’s Hospital between November 2018 and April 2024 were retrospectively analyzed. Among these patients, 29 underwent “Tianji” robot-assisted surgery (Robot group), and 31 underwent traditional C-arm fluoroscopy-assisted open surgery (Open group). Statistical analysis of the data was performed using SPSS 27.0 software to compare general data (gender, age, BMI), preoperative and postoperative visual analogue scale (VAS) scores, neck disability index (NDI), intraoperative blood loss, accuracy of screw placement on imaging, and the number of complications in both groups for comprehensive evaluation. A P value < 0.05 was deemed to have achieved statistical significance. Results: There was no significant difference in preoperative VAS scores between the two groups (Robot group: 8.34 ± 0.61;Open group: 8.26 ± 0.68, P = 0.317). There was also no significant difference in VAS scores at 1 week postoperatively (Robot group: 6.90 ± 0.31;Open group: 6.94 ± 0.36, P = 0.3237). Preoperative NDI scores showed no significant difference between the two groups (Robot group: 43.31 ± 2.67;Open group: 43.84 ± 2.67, P = 0.2227), and the difference in NDI scores at 1 week postoperatively was also not significant (Robot group: 35.69 ± 4.24;Open group: 37.35 ± 3.48, P = 0.0509). Intraoperative blood loss in the Robot group was significantly lower than in the Open group (246.21 ± 209 ml vs 380.65 ± 328.04 ml, P = 0.0308), with a statistically significant difference. The operation time was longer in the Robot group (3.75 ± 0.74 h) compared to the Open group (2.74 ± 0.86 h). In terms of screw placement accuracy, the Robot group had a higher accuracy rate for Class A screws compared to the Open group (102 screws vs 94 screws, P = 0.0487), and the accuracy rate for Class B screws was also higher in the Robot group (13 screws vs 29 screws, P = 0.0333), with both differences being statistically significant. There was no significant difference in the number of complications between the two groups (Robot group: 8 cases;Open group: 10 cases, P = 0.6931). Conclusion: Patients treated with “Tianji” robot-assisted surgery for upper cervical vertebrae fracture had lower intraoperative blood loss and higher screw placement accuracy compared to those undergoing traditional C-arm fluoroscopy-assisted open surgery, indicating that this robot-assisted surgery can effectively reduce intraoperative blood loss and improve screw placement accuracy.